Background: Data is lacking regarding the safety and efficacy of powered tools across the spectrum of patients requiring transvenous lead extraction (TLE).
Objective: To assess the efficacy and safety (rate of major and minor peri-procedural complications) of laser and mechanical extraction tools.
Methods: We performed a retrospective multi-centre cohort study of consecutive patients undergoing TLE utilizing laser and powered mechanical extraction tools at 8 of the 10 Canadian extraction centers. Patient and lead characteristics as well as indications and outcomes were analyzed. The primary outcome was the rate of cardiac or vascular perforation, as well as other major and minor complications. Secondary outcomes included demographic and patient characteristics and variability between centers regarding indications and outcomes.
Results: From July 1996 to July 2016, a total of 4527 chronic endovascular leads were removed from 2352 patients. Mean age was 61.9 ± 16.5 years, 29% were female. The mean EF of patients in the study was 42.9 ± 15.7% with 82.3% having NYHA class I or II symptoms. The most common indication for extraction was infection (48.3%), with large variability between centers (28.3% to 88.8%). The mean dwell time was 8.1 ± 5.7 years and 5.7 ± 3.6 years for the 2823 and 1195 completely removed pacing and ICD leads respectively. Leads designated as functionally active composed 80.2% of leads and abandoned leads composed 17.5%. The mean rate of total lead removal was 92.2% (range 86.7% to 97.8%) in cases of infection, but 68.2% in patients with non-infectious indication for extraction. A mean of 12% of leads were categorized as advisory leads. A cardiovascular surgeon performed the procedure in 80% of cases and 86.4% were performed in a surgical OR or hybrid room. Cardiac and/or vascular perforation occurred in 63 of 2325 patients (2.7%). Surgical repair was performed in 54 (85.7%) and pericardiocentesis in 12 (19.4%) patients. The 30-day mortality of the total cohort was 1.6% (38 patients) and the mortality if a perforation occurred was 15.9% (10/63).
Conclusion: Broad variability was present when examining indications and outcomes from a population of TLE patients. Overall mortality was low despite a higher than expected rate of cardiac and vascular perforation.